Feb 23, 2024 NR 451 Week 1 Discussion Types of Nursing Models and Frameworks of EBP
NR 451 Week 1 Discussion Types of Nursing Models and Frameworks of EBP Recent
Types of Nursing Models and Frameworks of EBP
What are some of the models and frameworks of EBP currently in use? How does the strength of the evidence determine translation into practice? Why is it important to integrate both evidence-based practice and patient and family preferences? What is the nurse’s responsibility when EBP and patient and family practice do not match?
Professor I agree with your post. I finished my LPN in 2009. I do not remember learning anything about EBP. I received my ADN in 2013. I may remember my professor mentioning EBP but not in detail. I was thinking that it only came about in the last 2 years. To read in this post that it arrived before I was born is new news to me. While obtaining this degree I have learned to evaluate research and evidence. This has helped me to understand EBP and its importance. “EBP is important because it aims to provide the most effective care that is available, with the aim of improving patient outcomes. Patients expect to receive the most effective care based on the best available evidence. EBP promotes an attitude of inquiry in health professionals and starts us thinking about: Why am I doing this in this way?” “EBP is important because it aims to provide the most effective care that is available, with the aim of improving patient outcomes. Patients expect to receive the most effective care based on the best available evidence.”
http://canberra.libguides.com/evidence
I agree that each patient is different and we should use the best practice depending on that patient. Sometimes as nurses we may struggle at times on how to find the right practice for a patient. The patients beliefs may interfere with the best practice. You are correct when you say the patient preference is the “trump card”. In the nursing home with new regulations it is very important to follow what the residents like. For instance if the resident is a pureed diet for swallowing reason, but they say I want a hamburger with fries we have to honor that! The state says they have the right to eat what they want even if it goes against safety reasons.
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Great discussion this week. I agree with you that EBP is not a new concept and started with Florence Nightingale. Also the importance of using the models to develop different approaches for nurses giving care to patients. Your explanation about rating EBP is great and something that was I unaware of. Also using the nursing process to prove the EBP is important as well. I also agree that is of the greatest importance that the patient is willing to be a part of the EBP if the research is still being completed, or even when the research is completed, and the EBP is placed into practice. According to Veterans Health Administration Office of Nursing Services (2017), “Evidence isn’t actionable without the patient. In EBP, patient preferences are the “trump card”. Patients can’t have a preference if they don’t have (or aren’t given) a choice; and, patients can’t have a choice if they aren’t truly informed of all options.” Again great post.
Reference:
Veterans Health Administration Office of Nursing Services. (2017). Evidence-Based Practice Curriculum: Patient Preferences. Received from https://www.va.gov/nursing/ebp/docs/DefiningPatientPreferencesCurriculum_www.pdf
There are many different models and frameworks that are currently used for evidence based practice. One includes the ACE Star Model of Knowledge. This nursing model of EBP is a good starting for place for nurses as it incorporates five points to help the nurse integrate new practice. “The model of evidence translation that will prove most useful depends on the type of practice, the setting, and the practitioner’s needs(Houser,2018, p.468). The stronger the research the more informative a nurse can be about translating it into their practice. While implementing the evidence nurse have to take the patient into consideration as they may not agree with the new practices.
As nurses, we are taught to respect the patient and the family preferences to make sure the patient receives the best care possible. If the patient and family does not agree with EBP the nurse can try to educate the patient and family. If at the end of the education they still do not agree respect the wishes of the patient and family, and take care of the patient with other methods that they wish to be taken care of. As nurses, we are taught to critically think, and adjust our practices to individualize for each patient that we meet. “EBP is aimed at hardwiring current knowledge into common care decision to improve care processes and patient outcomes”(Steven, 2013, p.2)
Lesson Week 1
Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.).Sudbury, MA: Jones and Bartlett.
Stevens, K. R. (2013). The impact of evidence-based practice in nursing and the next big ideas. Online Journal of Issues in Nursing, 18(2), manuscript 4.doi:10.3912/OJIN.Vol18No02Man04.
I enjoyed reading your post. It sometimes seems that we are caught in situations where we must make judgment calls and our own ethics play a role. It is often difficult to step back and allow the patient’s wishes to “trump” what we know is best from a medical point of view. Emotions play a large role in why each person makes the decision he / she does. I often have to remind myself that what is physically best for the patient is not what may be emotionally best for him / her.
Good post. I enjoyed reading your response. I agree with you, The ACE star model of knowledge is a great starting point for nurses. According to Bonis (2007), the model is used to convert knowledge to outcomes through evidence based practice which is now being implemented into nursing programs because the overall passing standards for becoming a nurse has increased. When patients and family members do not agree with the practice or care, strong research is how we can support our EBP in nursing. We must also allow them to make their own decisions, but we must educate them and allow them to be informed of care and the situation of the patient. We must not become biased and allow the patient and family to make their own choices whether we agree with them or not. I like you statement that “we must adjust our practices for each patient we meet”.
Reference:
Bonis, S., Taft, L., & Wendler, M. (2007). Strategies to promote success on the NCLEX-RN: an evidence-based approach using the ACE Star Model of Knowledge Transformation. Nursing Education Perspectives (National League For Nursing), 28(2), 82-87.
This week’s lesson listed five different EBP models (CCN, 2017):
The John’s Hopkins Nursing Evidence-Based Practice Model (JHNNEBP)
The Stetler Model
The Advancing Research and Clinical Practice through Close Collaboration Model (ARCC)
The Iowa EBP Model
The Promoting Action on Research Implementation in Health Service Framework (PARIHS)
These models provide the direction or roadmap to guide new strategies for care when new research has been identified. When a problem has been identified, you must first collect internal data to support the problems exists. The next step is find data to determine the magnitude of the problem, along with its causes. The final step is to analyze your findings. Not all nursing models of EBP will fit all organizations (CCN, 2017). Prior to the last class, EBP NR439, I really wasn’t too familiar with the term EBP. As I reflect and have more knowledge, I know see the Iowa EBP Model was and is used in my current practice to most of our daily care.
This all took place several years back, never labeled as EBP. I now know the painstaking time and energy that went into all of these algorithm changes. It did create an uproar and we were wondering, “Why can’t we just do what we have always done”? Many of the changes came with the care of pregnant hypertensive patients and hyperemetic patients. It all made sense after our organization provided us with an in-service and support. But, today we still have some who just can’t see past the old ways. The introduction of EBP has made caring for the patient much more efficient and prevents unnecessary interventions and reduces costs.
As stated by Houser (2018, p. 25), “Based on the strength of the evidence and the preponderance of benefit or harm, recommendations are generated that are classified as strongly recommended, optional, or recommended. Evidence collected by research studies are graded based on the strength. Vigilant evaluation of specific characteristics matched with an assessment of the credibility and validity of the studies is essential before carrying out changes. Evidence that supports better patient outcomes, efficient, effective care and reduction in errors is what gets translated to practice.
When we integrate EBP with patient and family preferences, it allows us to design and develop appropriate and acceptable interventions tailored to that patient/family unit. By doing so we are implementing PFCC and allowing the patient/family to be active participants. As nurses, we provide the knowledge, resources, and support each patient needs to be involved in informed decision making processes and assume important aspects of self-care (Hood, 2014, p. 408). The patient is not exclusive in PFCC as most people are part of a family. Personal preferences, values, family dynamics, religious and cultural traditions must all be taken into consideration.
Healthcare providers and patients approach clinical care and treatment differently. First and foremost, it is my obligation and duty to uphold the patient and or family’s preferences. We have a duty to care according to the patient’s wishes. So it is inevitable that there will be a time when EBP and the patient and family practice are at odds and don’t agree. There will always be these dilemmas. According to Siminoff (2013), PFCC increases treatment adherence and better outcomes. The family influence has a significant impact on health care decisions. Working with the patient and family and understanding their approach and decisions is important. Understanding that illness is not just a biological process but also a social process. Open commination and actively listening to the patient/family to make sure there is no misunderstandings about the EBP practice chosen is important.
The decision to be an active participant is the patient’s to make, not ours. Increased patient involvement is an important part of quality improvement because it is associated with improved health outcomes (Say & Thompson, 2003). With that being said, we must abide by our patients wishes. Several years back I can remember taking care a very sick hyperemesis patient who was Orthodox Jew. She was to be started on a sq Ondansetron pump, but because it was religious fast day, Yom Kippur, we could not start her until the fast was completed. I was so upset as this woman was already very sick and not eating or starting her therapy meant even more insult to her already depleted condition. After talking with her and listening, I understood the importance of this religious day and nothing I could say would change her mind. I did more research myself and came to realize the significance of this day for her. Cleary, compromise and allowing the patient to be the driver in her care was the best approach to take.
References,
Chamberlain College of Nursing. (2107) NR451 Week online lesson. Collaborative Healthcare: Chamberlain College of Nursing. Downers Grove Il
Siminoff L. Incorporating patient and family preferences into evidence-based medicine. BMC Medical Informatics And Decision Making [serial online]. 2013;13 Suppl 3:S6. Available from: MEDLINE Complete, Ipswich, MA. Accessed August 23, 2017.
Say, R. E., & Thomson, R. (2003). The importance of patient preferences in treatment decisions-challenges for doctors. BMJ: British Medical Journal, 327(7414),542. doi:http://dx.doi.org.proxy.chamberlain.edu:8080/10.1136/bmj.327.7414.542
thank you for this weeks’ insight. Thank you for sharing a part of your own practice experience as well as your personal growth. In our textbook, (ANA,2015,pg.12) , there is a section on caring. It states caring is
* grounded in ethics, beginning with respect for the autonomy of the care recipient.
* grounded, as a science, in nursing, but not limited to nursing
* an attribute that may be taught, modeled, learned, mastered
* Capable of being measured and analyzed scientifically
* The subject of study within caring science institute/academic worldwide
*Central to relationships that lead to effective haling cure, and/or actualization of human potential
As many of you have discussed, our own values, beliefs and preference, even knowledge does not supersede those of our patients. As with this patient, medically the intervention was necessary and important, however, to the patient her loyalty, her “faith” of what/who she believed her hope was in, was of a spiritual nature first, then the physical. As nurses we must care for the physical, the emotional and the spiritual part of our patients despite our own beliefs. As patients face physical and emotional distress they also frequently experience spiritual unrest. As the patient advocate and caretaker ,it is often the nurse that can comfort and connect with the patient to enable them to confide their most inner fears and thoughts. As a NICU nurse, I have been asked to join hands and pray, participate in the baptism of an infant that is near death. This total care approach can often be uncomfortable. It is important to have working knowledge of major religions, as society, culture and religion is often interweaved. One article, Religion in Nursing, states,” there is strength in a diverse yet united approach to the challenge of spiritual care in nursing practice.
American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author
(2017).Religion in Nursing retrieved from http://www.NursingLinks to an external site. School Hub.com
I agree, the spiritual part of the patients beliefs can be uncomfortable at times especially if it is in direct conflict with our own spiritual beliefs. Setting aside our own beliefs and honoring those of the patient can be a nurses biggest challenges in practice.
As a human factor, nurses may know what they believe to be best in medical care and want to force this onto a patient. The doctor-patient relationship is important in influencing a patients beliefs or attitude toward medicine (Clyne, 2017). The stronger the relationship the better the influence. Nurses have relationships with patients that may not be as respected as the doctors. If a doctor’s and a nurse’s values disassociate with each other, added challenges may exist to promoting change.
The power of spiritual beliefs is a true challenge to changing a patient’s perspective to change in medical care. If there is a mismatch of beliefs it could severely impact what is the best therapy. A nurse has an added responsibility to have knowledge not only of EBP, but what beliefs a patient may have to encourage change.
Clyne, B., Cooper, J. A., Boland, F., Hughes, C. M., Fahey, T., & Smith, S. M. (2017). Beliefs about prescribed medication among older patients with polypharmacy: a mixed methods study in primary care. The British Journal Of General Practice: The Journal Of The Royal College Of General Practitioners, 67(660), e507-e518. doi:10.3399/bjgp17X691073
Does anyone in the class remember asking in nursing school “why” something is done and the answer was “because it has always been done that way” When I went to nursing school (for the first round) Evidence based practice was not heard of. We did things because it was tradition, or that is how we do it here, or that is how I was taught to do it. Outcomes were really not thought of. There was no evi
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